Über den Autor
Spanos E, Fischer C
Influence of scaling procedures on the integrity of titanium nitride-coated CAD/CAM abutments
Background and aim
There is considerable evidence to support the view that the long-term success of an implant rehabilitation significantly depends upon a proper peri-implant soft tissue integration, serving as a protective barrier between the oral environment and the underlying peri-implant bone. Peri-implant mucosa is generally recognized as a hypovascular and hypocellular scar tissue. It is immunologically highly inferior to the periodontal tissues around teeth, since it exhibits an impaired resistance to bacterial colonization. Consistent plaque control is therefore essential for the prevention of inflammatory peri-implant disease. Manual instruments and ultrasonic scalers have been effective for removal of plaque. However, not all of these instruments are suitable for removing plaque from implants or abutments.3 In particular, treatment with steel curettes and ultrasonic scalers with steel tips cause sustained damage to the implant surface. The resulting roughness on the surface of implants and abutments may increase plaque retention.4 Therefore, the aim of the in vitro study was to investigate the extent of treatment traces, the roughness depth (Sa;Sz), and the quantity of titanium or TiN removed from the surface after treatment with various instruments.
To determine the extent of treatment traces, the roughness depth, and the quantity of titanium nitride (TiN) removed from the surface of CAD/CAM abutments after treatment with various instruments.
Material and methods
12 TiN-coated custom CAD/CAM abutments (Atlantis GoldHue, Dentsply Sirona Implants, Mölndal, Sweden) were investigated for an in vitro study. In the test group (nine) each abutment surface was subjected twice (labial aspect with 150 g and oral aspect with 200 g pressure, two 2 x 2-mm test fields on each abutment) to standardized treatment in a simulated prophylaxis measure with the following instruments: acrylic curettes (three abutments), titanium curettes (three abutments) and ultrasonic scaler with a steel tip (three abutments). Three other abutments were not treated and used as control group. The roughness depth (Sa;Sz) and profile height of treated and untreated surfaces were measured with a profilometer (focus variation microscopy); profile height served as a basis for determining the amount of substance removed by treatment. The treatment traces were analyzed by scanning electron microscopy (SEM).
While acrylic curettes caused no damage to the TiN surface, both the ultrasonic scaler with a steel tip and the titanium curettes left pronounced traces on the abutments and increased Sa; Sz. Substantial substance removal was recorded following instrumentation of ultrasonic scaler. A planing effect and Sa decrease was observed.
Discussion and conclusion
Reports have characterized TiN as chemically inert and biocompatible.1,2 TiN-coated CAD/CAM abutments are clinically used to achieve a warm, esthetic tone under the mucosa because of its gold shaded hue. However, inapropriate instruments during regular recall and plaque control measures may have an adverse effect on the integrity of the coating. The resulting roughness could increase plaque and bacteria retention. To prevent resolution defects and/or increased surface roughness at the transmucosal zone of TiN-coated CAD/CAM abutments, only acrylic scaling instruments can be recommended for plaque control measures.
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After instrumentation with ultrasonic instruments a significant increase of treatment traces with greater roughness depth and detachment of the TiN-layer was observed. The severity of damage increased from utilizing titanium curettes to ultrasonic scalers. Ultrasonic scaling led to an entire detachment of the TiN-coating in combination with a planning effect of the surface. The variable contact pressure did yield no statistically significant difference: Sa (p = 0.8), Sdr (p = 0.242), coating detachment (p = 0.843) and treatment traces (p = 1.00). TiN-coated CAD/CAM abutments displayed no treatment traces, no alterations of roughness depth, and no detectable substance removal after manipulation with acrylic curettes. A concern, however, is the organic material located on the abutment surface due to wear of friction of the acrylic tip of the instrument. The biological consequences of implant or abutment contamination with plastic residues are critically discussed.5